Beshear speaks at the Good Morning Bluegrass event in Lexington. (Photo by Melissa Landon)

Gov. Steve Beshear focused on health issues in remarks to a civic meeting Friday in Lexington. "We are leading this country in economic development, in education reform and in providing health care for our people," he said, noting the progress Kentucky is making in health and the direction it will go in the future.

"Kentucky is one of the least healthy states in the country," Beshear said. "I'm not proud of that." He said he knew something had to be done about it—then along came the Patient Protection and Affordable Care Act.

"You can like it; you can not like it, but for the first time in our history . . . we've got a tool to provide affordable health care for every single Kentuckian," Beshear said. He acknowledged the system is imperfect, but said Kentucky is recognized nationally as the model for health-insurance exchanges.

Beshear reported that almost 200,000 of the 640,000 previously uninsured Kentuckians have signed up for health care through the exchange, branded as Kynect. Most are in Medicaid, the free program for the poor; Beshear expanded the program to include people with incomes up to 138 percent of the federal poverty threshold.

The federal government will pay the cost of the expansion through 2016; the state will pay 3 percent in 2017, rising to the law's cap of 10 percent in 2020. A state-funded study said the expansion would create enough jobs to pay for itself, and Beshear said his emphasis on education and health would create jobs.

"A healthy workforce is the key to the future of the Commonwealth of Kentucky," because prospective employers are primarily concerned with whether an area has a healthy, trained educated workforce to help get the job done, the governor said. "The Affordable Care Act is giving us the opportunity to increase the healthiness of our workforce."

For a county-by-county list of Kynect signups for insurance and Medicaid, click here.

Thursday, January 30, 2014

Kentuckians' support of the federal health-reform law remains low, with only 30 percent saying they view it favorably and 48 percent unfavorably, but 57 percent said they didn't have enough information to say how the law would affect them personally.

Of those who said they did have enough information to know how the reform would affect them, 57 percent thought it would affect them favorably, and 39 percent said they thought it would affect them unfavorably. Among those who said they didn't have enough information, the results were almost exactly the reverse: 39.5 percent favorable and 59 percent unfavorable.

In the Kentucky Health Issues Poll, 66 percent of Kentucky adults said the law had no personal effect on them or their families. The poll was taken from late October to late November, the first and second months that the state health-insurance exchange created under the law was open.

The exchange offers private insurance plans for individuals and small businesses, and the opportunity for low-income people to sign up for the free Medicaid program. However, the health-insurance market in Kentucky is dominated by large groups, whose members are much less likely to realize the law's impact. The law has many other effects that are less visible, such as rebates from insurance companies that don't spend at least 80 percent of their premium revenue on health care. It may be too early in the game for most people to have discovered how exactly the new law will affect them.

The negative effects were clear for people who had to pay more for health insurance because their policies weren't sufficient to comply with the law. That showed in the poll's finding that 21 percent of Kentuckians reported that the it had affected them negatively, up from 16 percent in 2011. Seven percent said it had affected them positively, down from 11 percent in 2011.

The poll was funded by the Foundation for a Healthy Kentucky and Interact for Health, formerly the Health Foundation of Greater Cincinnati, and was conducted by researchers at the University of Cincinnati Oct. 25 through Nov. 26. Its error margin is plus or minus 2.5 percentage points.

A Public Policy Polling survey in earlly January yielded similar results regarding Kentuckians' views of the PPACA. According to this poll, only 30 percent of voters in Kentucky approved of the Affordable Care Act, while 56 percent did not approve. The majority—69 percent—believe the health reform has been a failure in the rest of the country, while 22 percent of Kentuckians believe it has been a success. "There's only so much voters in Kentucky are going to say nice about anything related to Obamacare, so even breaking even on the implementation numbers in the state seems to be a pretty big success for Beshear," the report said.

Wednesday, January 29, 2014

St. Joseph Hospital in London will pay $16.5 million to the federal government to settle charges that it got money from Medicare and the federal-state Medicaid program for unnecessary heart procedures, according to a document released Tuesday. The schemes and subsequent fines the hospital now faces may cause even more financial problems for KentuckyOne Health, Andrew Wolfson writes for The Courier-Journal.

Almost 400 former patients filed lawsuits, claiming cardiologists at the hospital performed "unnecessary, risky and often painful heart procedures to unjustly enrich themselves," Wolfson reports. According to the claims, two patients died and some will have to take blood-thinning medications for the rest of their lives, leaving them vulnerable to possibly fatal complications.

Several doctors at the hospital conducted unnecessary, invasive procedures such as heart stents and catheterizations on Medicare and Medicaid patients between 2008 and 2011, the government claimed; hospitals usually get $10,000 to $15,000 for each procedure, Wolfson notes.

"We all rely on health care providers to make treatment decisions based on clinical, not financial considerations," U.S. Attorney Kerry Harvey said in a news release. "The conduct alleged in this case violates that fundamental trust and squanders scarce public resources set aside for legitimate health care needs."

According to Harvey's office, the investigation continues because various doctors were involved, and their crimes are not absolved through the fine, Bill Estep reports for the Lexington Herald-Leader. For example, Dr. Sandesh R. Patil "pleaded guilty last year to lying about the severity of a patient's condition to make sure the government would pay for heart procedures," Estep reports. "Patil was sentenced to 30 months in prison."

Although St. Joseph London agreed to pay the $16.5 million, it did not admit violating the law, a common provison in such cases.. The hospital said it agreed to pay the penalty to avoid further expenses, "'uncertainty of prolonged litigation, and to allow the hospital to move forward.' It said the allegations arose in 'past relationships with some cardiologists who no longer practice at the hospital'," Wolfson reports.

St. Joseph President Greg Gerard said, "We are committed to providing the communities we serve with safe, high quality health care performed with the highest of integrity."

Three Central Baptist Hospital cardiologists in Lexington—Drs. Michael R. Jones, Paul W. Hollingsworth and Michael Rukavina—played a key role in discovering St. Joseph-London's malpractice, Estep reports. When they noticed that some patients they treated had been subjected to unnecessary procedures at London, they sued in 2011. "One patient who came to the Lexington practice had undergone 17 heart catheterizations—performed mostly by Patil—in London in four years, none of them necessary, according to the report," Estep writes. The three cardiologists will get $2,458,810 of the $16.5 million settlement, according to Harvey's office.

Although St. Joseph-London is finished with the civil portion of the case, the federal government will continue trying to get money from the doctors and clinics identified in the lawsuit, Harvey said. "This result would not be possible without the commitment of private citizens exposing this type of egregious fraud," said Perry K. Turner, special agent in charge of the FBI in Kentucky.

A program that promotes preventive health care and wellness initiatives has been embraced by Kentucky state employees who chose the Living Well health insurance plan.

The plan is called the Living Well Promise and was created in a partnership between Humana Inc. and the Kentucky Employees' Health Plan because 80 percent of the plan's health-care costs are going for treatment of chronic diseases. KEHP serves approximately 290,000 state employees, according to a Humana press release.

This year, 235,000 KEHP members, 81 percent of the total, signed up for the Living Well Promise, in which they agree to complete an online health assessment by May 1 and to keep the information current. They also get access to a comprehensive wellness and rewards program, a savings program for healthier foods at Walmart and access to health coaches. Pregnant women, transplant patients and people with weight loss and other medical conditions get nursing support.

“Those who committed to the promise will receive lower coinsurance, deductibles and out-of-pocket maximums,” Joe Cowles, commissioner of the state Department of Employee Insurance, said in the release. “Employees will also have an in-depth view of their health and medical history through the health assessment. The assessment also provides a greater understanding of their risks and opportunities to take action to get and stay healthy.”

The program was a finalist in this year's Healthiest Employer's Award program, hosted by Louisville Business First.

Kids Cancer Alliance is taking applications for its annual Kids Cancer Alliance Survivor Scholarship, which gives young adult cancer survivors help toward their academic and professional goals.

Applicants must:
1) Have or have had cancer and have attended Indian Summer Camp between
the ages of 6 and 18.
2) Be a full time (minimum 12 credit hours per semester) student at an accredited
university, community college, vocational or technical school.
3) Be a citizen of the United States.
4) Return a completed application, school transcripts, completed essay and two letters of recommendation by April 1.
5) Apply for the Kids Cancer Alliance scholarship the first time by the age of 21. Funds may be awarded after 21 but no later than 25.
6) Demonstrate financial need.

Since 1981, Kids Cancer Alliance has offered a "normal" camping experience for children with cancer. It has recently expanded its services to also include the children with cancer's families, offering camps that include siblings, family retreats, quarterly events and in-hospital programs. Kids Cancer Alliance also offers free financial support to children with cancer and their families. Click here for more information.

Tuesday, January 28, 2014

As President Obama prepared to have Democratic Gov. Steve Beshear as his guest at the State of the Union address, Republican Sen. Mitch McConnell, running for re-election, continued his attack on the health-reform law that Beshear has embraced and has been dubbed with the president's name.

In a speech on the Senate floor Tuesday, McConnell said Obama and Beshear “can keep telling Americans to ‘get over it’ if they don’t like this
law, but sooner or later they’re going to have to come to terms with
reality. They’re going to have to accept that Obamacare just hasn’t worked
like the administration promised — in Kentucky, and across America — and
that it’s time to start over with real reform.” McConnell added, “More than a quarter million Kentuckians lost the plans they had and
presumably wanted to keep – despite the president’s promises to the
contrary.”

Beshear expanded the Medicaid program to people with annual incomes up to 138 percent of the federal poverty threshold, and was the only Southern governor to create a health-insurance exchange where people could buy private insurance or sign up for free Medicaid coverage. He did all that with federal money; the state will begin paying part of the cost of the newly eligible in 2017, reaching the law's cap of 10 percent in 2020.

“Kentucky has gotten more money to set up its exchange than every state
except California, New York, Oregon and Washington,” McConnell said.
“That’s a lot of money. And they’ve still only enrolled 30 percent of
the people they were supposed to at this point. How is that a success?” State officials say enrollment is picking up, and Beshear "said the rate of sign-ups has validated his decision to have a state-operated exchange," The Associated Pressreports.

The deadline for this year's coverage is March 31. In his Tuesday night speech, Obama asked "every American who knows someone without health insurance" to help get them enrolled by that date.

Just before that, he said, "If you want to know the real impact this law is having, just talk to Governor Steve Beshear of Kentucky, who’s here tonight. Now, Kentucky’s not the most liberal part of the country; that's not where I got my highest vote totals. But he’s like a man possessed when it comes to covering his commonwealth’s families."

Obama quoted lines that Beshear often gives about people who have gone without health insurance: “They are our friends and neighbors. They are people we shop and go to church with; farmers out on the tractors; grocery clerks; they are people who go to work every morning praying they don’t get sick. No one deserves to live that way.” Obama added, "Steve’s right."

Monday, January 27, 2014

Under fresh pressure from a coalition of health care and business groups, state lawmakers are discussing the long-lobbied idea to submit medical-malpractice lawsuits to review panels that could give initial opinions about their merit.

The Kentucky Hospital Association, the Kentucky Medical Association and the Kentucky Chamber of Commerce want the General Assembly to establish three-person panels to reduce the cost of defending and settling them, writes Bruce Schreiner of The Associated Press.
"Now is the time for Kentucky to say 'enough is enough' to meritless lawsuits, which are having a huge impact on health-care costs," said Chamber President and CEO David Adkisson. Advocates believe a negative opinion from a review panel would discourage some cases from moving forward or going to trial, and reduce the settlements that defendants might pay.

In 2013, the Senate passed a review-panel bill for nursing homes, but the idea failed in the House. Sen. Julie Denton, R-Louisville, chair of the Senate Health and Welfare Committee, said she hasn't decided whether the new bill she is preparing would be limited to nursing home cases, Schreiner reports.

Review panels are opposed by plaintiffs' lawyers and nursing-home reform groups such as AARP, formerly the American Association of Retired Persons. ""We haven't seen any evidence that similar legislation has improved the quality of care for nursing home residents" in other states, said Jim Kimbrough, state president of AARP. "What our state needs is to focus on improving the quality of care our seniors are receiving."

House Speaker Greg Stumbo, a plaintiffs' lawyer and Democrat from Prestonsburg, said Friday he is willing to contemplate "some reasonable sort" of review panels for malpractice suits against nursing homes. He said panel members should be allowed to testify in court, but the panel's findings should not be admissible.

Dr. Fred A. Williams Jr., president of the KMA, said review panels would help make "the state more attractive to employers while helping us retain and attract the kind of quality physicians and other health-care providers Kentuckians depend upon."

Stumbo expressed doubt that meritless lawsuits are as numerous as the bill's advocates say, saying weak cases are discouraged by the high cost of bringing malpractice cases to trial. "He also expressed doubts that the proposed changes would lower malpractice premiums paid by those in the health-care industry," Schreiner writes.

Kentucky's overall emergency-care environment, including its medical-malpractice laws, is the fifth worst in the nation, according to the American College of Emergency Physicians.

ACEP gave Kentucky a grade of “D” and ranked it 47th in the nation in its latest state-by-state report card. Kentucky ranked in the bottom half of the country in four of five categories, according to an ACEP press release.

“You know Kentucky has a problem when the best grade on a report card is a C,” Dr. Ryan Stanton, president of ACEP's Kentucky chapter, said in the release. “Out of five categories, we received two ‘F’s’ and two ‘D's’ for our support of emergency patients. That is unacceptable.”

The report card uses 136 measures in five categories to evaluate conditions under which emergency care is being delivered, not the quality of care provided by hospitals and emergency providers. Kentucky failed two of the categories: quality and patient-safety environment (43rd), due to a lack of statewide protocols and triage-and-destination policies for heart-attack victims, and medical liability environment (48th), for its lack of limits on medical malpractice lawsuits and a law that prevents a physician's apology from being admissible in court.

“Kentucky is effectively a judicial hellhole for physicians because of our poisonous liability environment,” Stanton said in the release.“We must have some protections for physicians who provide lifesaving care without a preexisting patient relationship and little to no knowledge of a patient’s medical history. Improvements in this area could help Kentucky attract and retain sufficient medical professionals.”

ACEP gave the state a “D” in Public Health and Injury Prevention (34th), which is related to the state having the highest rate of adult smoking in the country (29 percent) and among the highest rates of adult and childhood obesity (30.4 and 19.7 percent), says the release. It also received a “D” in Disaster Preparedness (33rd) in part because of the lack of loaw per-capita disaster-preparedness funding.

Kentucky's best score was a "C" in Emergency Care, ranking 12th, up from 19th in 2009, the last time ACEP ranked the states. The release says this improvement was largely due to increased access to accredited chest-pain centers, pediatric-specialty centers, psychiatric care and substance-abuse treatment, said the release.

Baptist Health Lexington, formerly Central Baptist Hospital, is undergoing a $230 million expansion that will make it better, not necessarily bigger, Dan Dickson reports for Business Lexington.

The expansion will not add beds to the hospital, which now has 383, but will update the space with the individual patient in mind, Dickson reports. “Everyone wants a private room when they don’t feel well,” hospital spokeswoman Ruth Ann Childers told Dickson.

The expansion of the Nicholasville Road campus began in the fall of 2010 and is expected to be completed late in 2015. It will include a seven-story, 200-bed hospital tower, a redesigned hospital entrance, a fourth underground parking garage, wider hallways with additional natural lighting, and an already completed cafeteria.

Baptist Health is based in Louisville and owns acute-care hospitals in Lexington, Louisville, Corbin, La Grange, Madisonville, Paducah and Richmond, and a long-term, acute-care hospital in Corbin. The system manages hospitals in Elizabethtown and Russell Springs.

The Kentucky Equal Justice Center, a non-profit advocacy organization most recently in the news for encouraging Obamacare enrollments, has won the Consumer Reports Excellence in Consumer Advocacy Award, which includes a cash prize of $25,000 to support the organization's work.

The group received the award for its positive impact over the years "as a watchdog and advocate for low income and other vulnerable residents of the state," says a press release from the magazine, published by Consumers Union.

The center has been instrumental in Kentucky's successful implementation of the Patient Protection and Affordable Care Act, the release notes, helping residents take full advantage of the available benefits and supporting expansion of the Medicaid program. It has also played a key role in making sure health insurers in the state follow the law's rule that 80 cents of every premium dollar must be spent on patient care, saving an estimated $1.3 million for Kentuckians in 2013, the release says.

The center helped lead efforts that protected $45 million in charitable assets when the nonprofit Kentucky Blue Cross & Blue Shield merged with Anthem, allocating the funds to create the Foundation for a Healthy Kentucky, which provides millions of dollars in grants to address unmet health care needs in the state.

“It’s just delightful that work by a small organization, persistently and well over a long period of time, will even be noticed,” said Rich Seckel, director of the Kentucky Equal Justice Center. “We deeply appreciate it.”

Sunday, January 26, 2014

A statewide law to protect people from secondhand smoke is "very important" for improving the overall health of Kentucky, the state's public-health commissioner said on the latest edition of KET's "Connections" interview show.

Gibson

Though some localities have smoking ordinances, they are not consistent, and most Kentuckians aren't protected from smokers, who make up more than 28 percent of the adult population, Dr. Stephanie Mayfield Gibson told host Renee Shaw. "We know that it's been part of the culture but we also have the statistics to show us that clean air will help us to do better overall."

Asked about property rights, one of the main objections to smoking bans, Mayfield said, "I'm a health official, so I look at the fact that in the nation we have 49,000 people a year we believe who die from exposure to secondhand smoke." She noted that soon after Lexington passed a ban 10 years ago, heart attacks and emergency-room visits for asthma declined significantly.

Asked if a higher cigarette tax is the next logical step, Mayfield said higher taxes do curb smoking but "It's going to take more than one thing to do it," including "coordinated school efforts," since 24 percent of Kentucky high-school students smoke.

"It's going to take a variety of activities," she said. "I think it's going to take all hands on deck with a variety of measures." Noting that smoking is more prevalent among lower-income people, she added, "There's a lot of education that ends to be done."

The half-hour interview, which touched on other issues including trans fats, will air again Thursday, Jan. 30 at 7:30 a.m. ET on KET2.

Statewide smoking-ban legislation has not garnered the votes to get a vote in either chamber of the General Assembly, but advocates say it has a better chance than ever this year. The legislation is House Bill 173, sponsored by Reps. Susan Westrom, D-Lexington, and Julie R. Adams, R-Louisville.

Saturday, January 25, 2014

A bill to allow school personnel to administer insulin and otherwise treat diabetes symptoms if they undergo specified training is headed to the House floor. House Bill 98 reflects a shortage of school nurses and Kentucky's higher-than-average prevalence of diabetes.

A concern was raised in committee Thursday that a non-medical professional may not remember critical information if much time elapses between training and the need to use it, suggesting that non-medical professional will remember, reports Stu Johnson of WEKU-FM.

“If you’re just a little bit off on calculating those carbs, if you’re just a little bit off on calculating that insulin, you can do great harm," said Rep. Ben Waide, R-Madisonville. "So, the person who’s trained in August, and this doesn’t come up until April, and suddenly they’re going oh, smack, what was I trained in, what in August, what am I supposed to do.”

Teresa Combs of the Kentucky School Boards Association said a more likely scenario is that caregivers will have consistent interaction with the diabetic student, Johnson reports. "It's not always gonna be an emergency situation, but they're gonna be working with the kid all the time. I see that as better under this piece of legislation than it was when you had the nurse doing it," Combs said. "Unless the nurse just wasn't in the building and there was an emergency and then someone would have to step up that got trained five months ago.”

If schools don't have a nurse, parents must be called in to the school to administer insulin to their children, or the children are bused across the county to a school that has a nurse, Rep. Bob Damron, D-Nicholasville and sponsor of the bill, toldThe Jessamine Journal. Lori Bradley, mother of a diabetic, said she traveled 40 minutes from her work to administer insulin for her son while he was at school and eventually made the decision to resign: “I chose to resign rather than to risk losing my job, to risk being fired because of poor attendance and the numerous phone calls I received on a daily basis from the school.”

Stewart Perry of the American Diabetes Association said that no firm figures exist on how many children with diabetes are in Kentucky schools, but said "the number is growing at an alarming rate." (Read more)

Friday, January 24, 2014

Kentuckians strongly support Gov. Steve Beshear's decision to make hundreds of thousands more of them eligible for Medicaid under the federal health-reform law, according to a statewide poll taken last fall.

Democrats, Republicans, independents and all demographic and geographic groups defined in the poll largely supported Medicaid expansion and said it was important that the federal-state program provide coverage to low-income people. Beshear's move doubled the income eligibility level to 138 percent of the federal poverty threshold, from 69 percent. In 2012, the threshold was $15,415 for a single person and $30,675 for a family of four.

The poll found that 79 percent of Kentucky adults favored expansion, with 51 percent strongly favoring it and 28 percent favoring it somewhat; 87 percent said that it is very important (57 percent) or somewhat important (30 percent) that Medicaid provide coverage to low-income people.

Several Republican leaders have opposed Medicaid expansion, but 60 percent of Republicans in the poll said they favored it (33 percent "somewhat" and 27 percent "strongly"). Among independents and Democrats, respectively, the numbers were 83 percent and 90 percent.

The margin of error in the Kentucky Health Issues Poll was plus or minus 2.5 percentage points. The poll randomly surveyed 1,551 Kentucky adults by telephone, with 951 land-line interviews and 600 cell-phone interviews Oct. 25 through Nov. 26. The poll is sponsored by the Foundation for a Healthy Kentucky and Interact for Health, formerly the Health Foundation of Greater Cincinnati.

Under the Patient Protection and Affordable Care Act, the federal government will pay the cost of all the newly eligible Medicaid recipients through 2016. From 2017 to 2020, the state's share will rise in steps to 10 percent.

An estimated 308,000 uninsured Kentuckians qualify for Medicaid, according to the Kentucky Cabinet for Health and Family Services, and can find out if they qualify for Medicaid coverage at Kynect, the state's health-insurance marketplace.

By Melissa Landon and Al Cross
Kentucky Health NewsKynect, Kentucky's online marketplace for health insurance, launched on Oct. 1 under the federal health-reform law. In a poll taken from Oct. 26 to Nov. 25, about 77 percent of Kentuckians said they knew about it, but only 70 percent of those without health coverage said they did.

Kynect has used federal funds for a heavy advertising and outreach campaign, but the Kentucky Health Issues Poll found that 30 percent of the uninsured had heard "only a little" about it, and another 30 percent said they had heard "nothing at all," the phrases used in the poll. While they have had more time since the poll to learn about the exchange, the poll results suggest that more outreach is needed to fulfill the law's objective of getting health coverage for as many people as possible. March 31 is this year's enrollment deadline.

Kynect Executive Director Carrie Banahan told Linda Blackford of the Lexington Herald-Leader that the ads and outreach will continue, and the exchange is making extra efforts to reach young people. The poll found that among people aged 18 to 29, adults without high-school diplomas, residents of Northern Kentucky, and people whose household income is 138 percent or less of the federal poverty threshold, 32 percent of each group "reported hearing 'nothing at all' about Kynect," said the Foundation for a Healthy Kentucky, which sponsored the poll with Interact for Health, formerly the Health Foundation of Greater Cincinnati.

The report mentioned those earning 138 percent of poverty or less because they are newly eligible for free coverage under Medicaid, the federal-state program for the poor and disabled. Those who make more, up to $94,000 for a family of four, are eligible for federal tax subsidies for policies bought through Kynect. On the exchange, people can find out whether they are qualified for Medicaid and the Kentucky Children's Health Insurance Program, look for individual and small-business insurance plans, and see if they qualify for payment assistance or tax credits.

The poll indicated that the uninsured are looking for information about Kynect. About 20 percent of adult Kentuckians reported seeking information about it, but 36 percent of uninsured adults did.

Appalachian Kentucky women often don't get available screening test for breast and cervical cancer because of embarrassment, lack of accurate information about availability and guidelines, and lack of encouragement from their doctors to get these test, University of Kentucky researchers have found.

The study also found that Appalachian women who never or rarely get mammograms, which screen for breast cancer, usually don't get pap-smears, which screen for cervical cancer, either, Allison Perry reports for UKNow.

Appalachian Kentucky has a 17 percent higher overall cancer death rate than the rest of the country, with a 67 percent higher incidence of invasive cervical cancer and a 33 percent higher death rate of invasive cervical cancer. Breast cancer is the 3rd leading cause of cancer in Kentucky.

Researchers talked to 222 women in six rural counties in Appalachian Kentucky to assess whether they followed cancer screening guidelines. The study, published in the journal Women & Health, found that 33 percent of the women had recently been screened for both breast and ovarian cancers and 48 percent were rarely or had never been screened for both.

The study also found four common reasons that would increase the odds that these women would never or rarely get screenings for breast and cervical cancer: embarrassment to get the test, a belief that not having insurance makes it difficult to get a Pap test, belief that a mammogram is only necessary if you have symptoms and lack of advice to get a mammogram from their doctor in the prior 12 months, Perry reports.

The belief that breast cancer screening is only necessary if a woman has symptoms is of particular concern to the researchers, Perry reports. Often, by the time a woman has symptoms or has a lump, the cancer has advanced. Women 40 and older should get a mammogram every one to two years. If all did, that could reduce the mortality rates by 20 to 25 percent over a decade, Perry reports.

"Our study findings reinforce the challenges to screening faced by many vulnerable and underserved women," said Nancy Schoenberg, lead author on the paper and professor of behavioral science at the UK College of Medicine, told Perry. "Whether they experience inadequate knowledge, as shown in this research, or inadequate resources, as shown in other studies, many women find it difficult to obtain optimal preventive health care. Facilitating optimal prevention will reduce the huge toll cancer takes on women, their families and their communities."

In an earlier paper, in Medical Anthropology Quarterly, Schoenberg and Elaine Drew of the Medical College of Wisconsin challenged the longstanding notion that fatalism (the belief in a lack of personal power or
control over destiny or fate) discourages Appalachians from modifying their health behaviors. Their studies of rural Appalachian women’s health
decisions surrounding cancer treatments "suggested that for
these women, numerous and complex factors—including inadequate access to health
services, a legacy of self-reliance, insufficient privacy, combined with a culturally
acceptable idiom of fatalism—foster the use of, but not necessarily a rigid conviction
in, the notion of fatalism," the study report says.

Thursday, January 23, 2014

Gov. Steve Beshear's proposed state budget includes money to expand oral health programs, screening for cervical and breast cancer, treatment for Kentuckians with brain injuries and programs to held disabled people stay in their homes or communities.

The largest pot of new money is $3.3 million for oral health, a subject to which Beshear has paid special attention since soon after he became governor in December 2007. His budget would expand preventive oral health programs in the Department of Public
Health, and add 10 dental hygiene sites in local
health departments over the two-year budget period, July 2014 through June 2016.

Beshear proposes $1
million to expand screenings through the Kentucky Women’s Cancer Screening
Program to increase breast and cervical cancer screening. The funds would also develop systems to help
women navigate the health-care system. The governor's office also noted that his budget would continue the $1 million annual funding for colon cancer screening for low-income, uninsured Kentuckians aged 50 to 64.

Beshear would add 303 slots during the budget period for the Acquired Brain Injury Waiver program, which provides intensive services and support to adults who have acquired brain injuries and are working to re-enter community life. He would also add 900 new slots to waiver programs in Medicaid that provide alternatives to institutional care for individuals with intellectual and developmental disabilities.

A news release from Beshear's office said $166.7 million the state is saving because of federal health reform would be reinvested in the the Cabinet for Health and Family Services. "While most state agencies face 5 percent cuts under the governor’s proposal, most public-health and mental health-programs are exempt from cuts," the release said. "Affordable Care Act savings to these agencies mean many services they provide will now be covered with federal funds."

Among cabinet spending not directly for health, Beshear's budget would restore a recent cut in slots for child-care assistance for the poor, fund staff for the Child Fatality Review Commission, and expand the Health Access Nurturing Development Services (HANDS) program for new and expectant parents."This program was expanded to families that already had children in high risk communities in 78 counties with the use of a federal grant," the release said. "Beshear proposes $11.6 million to replace that grant, and an additional $5 million to take this expansion to the rest of the state."

Though enrollment in private insurance under federal health reform has been slower in Kentucky and other states than advocates hoped, Medicaid enrollment has skyrocketed in the state and others that chose to expand the program. In West Virginia, which has even higher poverty rates and shorter life spans than Kentucky, more than 75,000 people have enrolled in the federal-state program for the poor and disabled. Most were not previously insured, so the number of West Virginians without health coverage has gone down by a third, Sabrina Tavernise writes for The New York Times, in a story that could be replicated in Kentucky.

"America ranks near the bottom of developed countries in health and longevity, and many public health experts believe that improving that ranking will be impossible without paying more attention to poor Americans," Tavernise writes. That is being debated, but in the short term, many who have gained coverage have shown improvements in mental health, because they don't have to worry about paying unmanageable medical bills or finding a doctor's office that will accept the uninsured, she writes: "You see it in their faces," said Janie Hovatter, a patient advocate at Cabin Creek Health Systems, a southern West Virginia health clinic. "They just kind of relax."

Some in rural areas resist signing up because they don't like President Obama; in Eastern Kentucky and West Virginia, he is blamed for decimation of the coal industry. "Recruiters trying to persuade people to enroll say they sometimes feel like drug peddlers," Tavernise writes. However, many people are putting their need for healthcare over their dislike of the president. Rachel Williams, a McDonald's worker from Mingo County who didn't have insurance, would not fill out insurance forms when she went to the emergency room because of kidney stones. But later, when she found out she qualified for Medicaid, she signed up right away.

Studies show that 10 percent of premature deaths in the U.S. are caused by lack of access to medical care, while 40 percent are caused by behaviors like smoking and eating unhealthy food. "The rest is linked to genetics and social and environmental factors," Tavernise reports. Lavetta Hutchinson, a nurse in McDowell County, told her the law won't do much to improve health, especially that of the many people who have turned to drugs because of a lack of education and economic opportunity. "People don't see the value of prevention," Hutchinson said. Living better is more expensive, Tavernise notes: "Poverty is short-term thinking—what can I do today to survive," said Sister Janet Peterworth, a charity worker in Mingo County who is enrolling people.

Others see the new accessibility of health coverage as a stepping stone for increased health among the poor. Many Mingo County Diabetes Coalition patients could previously afford only food or medicine, social worker Gina Justice told Tavernise. "If you can take away that stress because now you've got a medical card, then you can focus on healthier eating that will help with these medical issues," Justice said. (Read more)

Monday, January 20, 2014

Randy Jackson, 50, of Louisville, said he's smoked for 20 years.(Photo by Aaron Borton, special to The Courier-Journal)

"Kentucky has failed to keep up with the nation’s gains in limiting tobacco use, outlined in the U.S. Surgeon General’s just-released 50th anniversary report on smoking and health," points out Laura Ungar of The Courier-Journal in a story tracing the changes since the report.

"Since
1965, the report says, the percentage of U.S. smokers dropped from 42
to 18. But state-by-state statistics that date to 1995 show Kentucky has
actually lost ground, with smoking rates rising half a percentage point
— even as the nation’s rate dropped by five points." The state's rate is 28.3 percent.

Why is that? ”Kentucky is historically a tobacco-growing state, and many tobacco companies previously were here,” Richard Baumgartner, professor and chairman of epidemiology and population health at the University of Louisville, told Ungar. ”And there’s a longstanding culture of growing
tobacco and smoking tobacco. It’s sort of ingrained.”

Ungar notes, "Kentucky has not been able to pass a statewide smoking ban, and the state spends a small fraction of the $57 million a year the U.S. Centers for Disease Control and Prevention
recommends for tobacco prevention — just $2.1 million in each of the
last two fiscal years. And state cigarette taxes are 60 cents a pack,
compared with a national average of $1.53."

Meanwhile, the state leads the nation in lung cancer and deaths from it, and ranks high in other forms of cancer that can be caused by tobacco. "In Kentucky, 7,800 residents a year die of smoking-related illnesses,
nearly a quarter of high school students smoke, and direct healthcare
costs attributed to smoking total $1.5 billion a year," Ungar writes.

Sunday, January 19, 2014

The University of Kentucky Children's Hospital plans to resume heart surgeries, following a suspension of the program prompted by the deaths of five children in 11 months and the departure of the hospital's only pediatric heart surgeon, reports CNN, which has been tracking the story for some time.

The hospital will hire a new surgeon and have an intensive care unit only for heart patients, will no longer perform the most difficult types of surgery to repair congenital heart defects, and may partner with another hospital for the work, reports Elizabeth Cohen, CNN's senior medical correspondent.

Cohen interviewed parents of the five children, who said they were upset that UK's 102-page report on the pediatric heart program didn't reveal why they died, and didn't even mention the deaths. "How do you know the problems have been fixed when they're not identified?" asked Kevin Allen, one of the parents. "They can say they fixed them, but is an internal review really objective?"

Cohen says in her report, "Shockingly, it seems no medical governing body is required to sign off on the hospital's decision to reopen the troubled unit," then shows part of her interview last May with Dr. Michael Karpf, the UK vice president who runs UK HealthCare, in which he says the only permission needed comes from him.

Asked if parents should trust the reopened unit to do a good job, Karpf said, "This is America. They have a choice. They can trust us or not trust us. All I can tell them is that I'm not going to reopen until I feel good about it. It's as simple as that."

The hospital declined to schedule an interview of Karpf for Cohen's latest story, so she tried to interview him as he was traveling. Asked why the children died, he replied that children also die after surgeries at other hospitals. Cohen reports, "But other hospitals are far more transparent. They tell how many babies died."

When Cohen asked Karpf if he could explain why so many children died at the hospital, he said "Our mortality [rate] fit the national standards." Cohen accuses him of "spinning the facts," and reports that the rate in 2012 was 7.1 percent, more than double the national rate of 3.2. UK says the rate for 2010-12 was 5.8, near the national rate of 5.3 for that period. (Watch the story)

Saturday, January 18, 2014

Jim Waters of the Bluegrass Institute, which bills itself as "Kentucky's free-market think tank," sees "reasonable doubt" in the recent Foundation for a Healthy Kentuckypoll that found two out of three Kentuckians favor a statewide ban on smoking in most public places. But he ignores some facts or makes selective use of them.

Waters, left, argues in his latest column distributed to Kentucky newspapers, "Proponents of a statewide smoking law know that if they offer a choice
in these polls, most would favor bans in public places but not on
privately owned property."

However, many "public places" are privately owned, such as restaurants and bars, and the poll question makes that clear: "Would you favor or oppose a state law in Kentucky that would prohibit smoking in most public places, including workplaces, public buildings, offices, restaurants and bars?"

The question has been the same since 2011, when the poll found that 54 percent of Kentucky adults favored the law while 43 percent opposed it. The gap increased to 59-38 in 2012, and in October and November 2013, it was 65-29.

Waters has another issue with the poll: "Where do respondents live? Residents from liberal urban areas may have different views than those farming tobacco in rural Kentucky."

The poll found support for the ban in Kentucky's most rural regions. In the 42 counties that the poll defines as Western Kentucky, which had been the region least supportive of a ban, the latest poll found it favored 65 to 30. A year earlier, the split was 53-44, with an error margin of 5.5 percentage points. In Appalachian Kentucky, the least supportive region, it is 62-34.

Waters contends that "Kentucky’s smoking rates are dropping without a statewide ban," but the statewide rate has declined very little in recent years, and remains the nation's highest, at 29 percent.

Waters also argues, "Even most privately owned establishments frequented by the public
have already accomplished what the supporters of a statewide ban claim
they want: smoke-free atmospheres for customers and workers. It’s
been at least 15 years since I went into a McDonald’s restaurant where
someone was smoking. Even some bars like The Crazy Fox in Newport boom
with business after voluntarily implementing bans. This all happened without a statewide law."

Thirty-eight Kentucky cities or counties have smoking bans, 24 of them comprehensive bans that include restaurants and bars. Those jurisdictions have about a third of Kentucky's population. Advocates of a statewide ban say it would impose consistency and protect non-smokers from secondhand smoke, which has been found to cause cancer and other diseases.

Finally, to the argument that employees in smoky workplaces may not be able to find a job in a smoke-free place, Waters writes, "There are lots of dangerous jobs – at nuclear power plants, along
busy interstates, on tops of bridges – where missteps bring death and
place others in harm’s way. Are we to ban heavy equipment because of
such danger? No one is forced to work in a smoke-filled restaurant, along a busy highway or on top of a bridge."

Such arguments, pro and con, will be aired tonight at 8 ET on KET's "Kentucky Tonight." Waters will be on the panel with Ken Moellman, spokesman for Northern Kentucky Choice, and two smoking-ban advocates: Dr. Shawn Jones, past president of the Kentucky Medical Association, and Ashli Watts,
manager of public affairs for the Kentucky Chamber of Commerce.

The Appalachian Regional Healthcare system has posted notices in its 10 hospitals that "provides an incorrect web address to sign up for federally mandated health coverage, falsely states uninsured patients won't receive non-emergency services after Jan. 1 and sets an arbitrary deadline to enroll for insurance" under the Patient Protection and Affordable Care Act, Mary Meehan of the Lexington Herald-Leader reports. "And CEO Joe Grossman is OK with that."

Grossman told Meehan that he dictated the notice's stern tone and established the Nov. 30 deadline for ARH patients to get insurance effective Jan. 1 to "build a sense of urgency" because he had heard patients say they had no incentive to sign up for health insurance. Meehan notes that the actual deadline was Dec. 23, and the deadline for the first year of enrollment is March 31; and that the chain serves "some of the poorest areas of the country. Ten percent of ARH's patients are uninsured," and Grossman said many don't pay taxes and this would not be subject to the fine for not having insurance.

ARH sent a letter with "the exact aggressive and misleading language" to 12,000 uninsured patients who received treatment at the hospitals in July, August and September.

"Cara Stewart, an attorney with the Kentucky Equal Justice Center, a nonprofit advocacy group," said the letter seemed like "fear mongering," Meehan reports. "Stewart emphasized that there is nothing in the ACA denying care for uninsured people. In fact, there are specific federal funds set aside to pay for uninsured care through 2020, she said." (Read more)

Friday, January 17, 2014

After years of lobby fights between doctors and advanced practice registered nurses, the state Senate has passed 36-1 a compromise version of legislation that would allow some APRNs to prescribe non-narcotic drugs without having an agreement with a physician. Advocates of the bill say it is needed more than ever now that federal health reform and expansion of Medicaid are bringing more people into the regular health-care system.

The bill's sponsor, Sen. Paul Hornback, R-Shelbyville, said it "will be the best thing for access to health care, for availability, for cost, for making sure we take care of our citizens here in Kentucky."

The House passed a bill last year to repeal the doctor-agreement law entirely, but it stalled in the Senate. Sen. John Schickel, R-Union, negotiated a deal with the APRNs and the doctors' lobby, the Kentucky Medical Association. The bill would allow APRNs who have practiced for four years to prescribe such medicine without any relationship with a doctor. It is now in the House.

This Kentucky Cancer Consortium graph shows the
deaths from cancers with evidence-based prevention
or early detection methods in Kentucky in 2005-09.

By Melissa Patrick
Kentucky Health News

Kentucky has the nation's highest rates of newly diagnosed cancers and death rate for all cancers combined, but Kentuckians could easily reduce those rates through proper screening and lifestyle changes, says a report from the Kentucky Cancer Consortium. Kentucky has a high death rate from lung, colon and cervical cancer, and leads in lung cancer deaths, with a rate almost 50 percent higher than the national rate.

The Nos. 1, 2 and 3 causes of cancer deaths in Kentucky, are lung, colon and breast cancer, and all three can be easily prevented or detected, according to the report.

Many risks associated with cancer are outside a person's control, but lifestyle changes and screening tools have been proven to reduce cancer risk and to catch cancer early, said Mark Varvares, M.D., director of the Saint Louis University Cancer Center.

“Healthy choices and preventive screenings won’t totally erase cancer, but they can reduce our risk in a really meaningful way," Varvares said in a news release. "They offer us the chance to change the course of the future, if we take advantage of them.”

According to the American Cancer Society, “More than half of all cancer deaths could be prevented by making healthy choices like not smoking, staying at a healthy weight, eating right, keeping active, and getting recommended screening tests.”

Specific suggestions made by the Saint Louis University Medical Center to reduce the risk of cancer are:

#1: Quit smoking. Smoking causes most lung cancer deaths in the U.S.

#2: Eat a healthy diet.
Obesity is a risk factor for many cancers, including those of the esophagus, pancreas, colon, and breast. A healthy diet includes foods like fruits, vegetables and whole grains, which also linked reduce cancer risk. Limiting red meats and processed meats can lower your risk of colorectal cancer. Many specific foods, like leafy green vegetables or blueberries, have been shown to have specific anti-cancer properties.

#3: Exercise. Studies show exercise lowers risk of colon and breast cancer. There also appear to be links between exercise and reduced prostate, lung and endometrial cancer risks.

#4 Limit alcohol. Excessive alcohol is bad for your health, and can raise the risk of certain types of cancer. For women, even a few drinks a week may increase breast cancer risk. The overuse of mouthwash, which contains alcohol, been linked to mouth cancer, Varvares said in the report. The recommended maximum amount of alcohol is two 4-ounce drinks per day for men and one for women.

#5: Wear sunscreen and avoid tanning beds altogether. Sunscreen, which blocks dangerous rays from the sun, is your best bet to avoid skin cancer. Tanning-bed users have a high incidence of skin cancer.

#6: Get screened. Colonoscopy, pap smears and mammography can be life-saving tools.

#7 Get vaccinated.
The human papilloma virus (HPV) vaccine lowers cervical-cancer rates in women, and is now being recommended for boys as well as girls partly because it shows promise in preventing head and neck cancer, too.

#8: Consider genetic counseling. This is a possible option for those with a family history of certain cancers, but should be a decision made with your doctor and with careful consideration of what you will do with the results. In deciding whether or not to have the screening, Suzanne Mahon, genetic counselor at Saint Lois University Cancer Center says, "Patients should ask ‘Is this something I really want to know about myself. If I know I am at high genetic risk of developing cancer, am I going to do something with this information?’"

Feeling under the weather? Be careful about exercising; doing it when sick can do more harm than good.

mensfitness.com photo

“Depending on where a person experiences symptoms of illness can make or break his or her workout and recovery,” Karin Richards, acting chair of the Philadelphia University of Sciences Department of Kinesiology, said in a news release.

“Those who experience above the neck symptoms such as stuffy noses and sneezing are generally fine to continue their exercise routine. However, those with symptoms below the neck such as a fever, nausea, and muscle aches are urged to stay in bed and recover.”

Flu is widespread in Kentucky, and one child's death has been attributed to it. Adult flu deaths do not have to be reported.

The flu virus can spread to others up to about six feet away, according to the federal Centers for Disease Control and Prevention. It is spread when infected people cough, sneeze or talk. It can also be spread by touching a surface or object that has flu virus on it and then touching your own mouth or nose. In other words, the flu is easily spread in fitness center environments and this is another reason to not exercise when you are sick.

Bed rest is advised for the flu. Here is a list of tips to help those with above-the-neck cold symptoms keep up their fitness goals:

Lower the intensity of your workout. If you usually run, walk.

Stretch. Yoga and gentle stretching can make you feel better and relieve congestion and pressure associated with sinus issues.

Workout only at home or outdoors until symptoms have gone away, so you don't infect others.

Stay active year round as a way to stay healthy and avoid getting sick.

“There is a fine line between a minor cold and the flu, and it’s important for individuals to stay in tune with their bodies,” Richards said. “A person’s body is stressed when fighting the infection, so placing additional stress through intense exercise only suppresses the immune system even more.” She also recommends seeking the advice of your doctor if you have any questions regarding continuation or resumption of your exercise routine.

Eight million lives have been saved as a result of the U.S. surgeon general's efforts for tobacco control says an article in theJournal of the American Medical Association.

Surgeon General Luther Terry jump-started America's efforts to battle diseases caused by smoking in 1964 with the release of a report that led to health warnings on tobacco products and the 1971 ban of smoking ads on TV and radio. It changed people's attitudes and brought attention to the issue.

Adult smoking rates have decreased by more than half since 1965, with a steady decline among children and adolescent smokers. Still, 43 million Americans smoke, and Kentucky has the highest smoking rate in the nation, 29 percent, according to the federal Centers for Disease Control and Prevention.

Since the initial report, there have been many advances in smoking-cessation methods, said Ellen R. Gritz, behavioral-science professor at the University of Texas' M. D. Anderson Cancer Center. The university has identified five critical developments that have advanced efforts to stop people from smoking and decrease lung cancer:

• Taxation: The report says that taxing tobacco products has made them less affordable and accessible to youth and lower-income people. “Taxation is the single most important factor in reducing smoking rates,” said Gritz.

• Regulation and legislation: Laws and rules include the required warnings on tobacco products, prohibition of advertising, insurance coverage of smoking-cessation treatment and, most recently, smoking bans in public places.

• Medications to help smokers quit:The Food and Drug Administration's approval of these medications have all shown a "strong positive effect" on smoking cessation efforts, the report says.

• Educational programs for children and adults: “Campaigns have changed the social norms in our society making tobacco use less socially acceptable, particularly among youth,” said Alexander Prokhorov, professor of behavioral science at M. D. Anderson.

• Cessation programs for smokers: People who want to quit smoking benefit from combined strategies, such as counseling and medication, which are often offered together in a formal program, according to the report. One of the main methods, Cooper-Clayton, was developed at the University of Kentucky.

Other efforts that may help people quit smoking, the report says, are continued studies of how the brain triggers the desire to smoke and the genetic predispositions of smokers, development of other counseling programs, increasing health-care providers' role in encouraging smokers to quit, targeting programs toward groups that are most susceptible to smoke, and lung cancer screening with low-dose CT scans. (Read more)

Thursday, January 16, 2014

A smoker in the Bullitt County Judicial Center last month.(Photo by Dana Rieber, special to The Courier-Journal)

Who should get to steer the no-smoking ship in Bullitt County? The county fiscal court passed an ordinance Wednesday night that banned smoking in public buildings but made it legal everywhere else, apparently negating the county health board's ban on smoking in most public places, passed by board regulation. The vote was 4-1, Bailey Loosemore reports for The Courier-Journal.

Fiscal Court members did not think the health board had the authority to pass such a regulation, and have appealed a state Court of Appeals decision to the contrary, Cedra Mayfield reports for WAVE-TV. "We all agree that an administrative body can pass regulations that regulate that administrative body, but it is the county's position that only a legislative body can pass a law," said Bullitt County Attorney Monic Robinson.

The effect of the ordinance on the lawsuit, now before the state Supreme Court, was not addressed by either news report. The health board could ask that the case be remanded to circuit court, where it could challenge the fiscal court's authority. The situation worries county health directors in Kentucky, who fear fiscal courts might try to override other types of local health regulations.

Wednesday, January 15, 2014

Two and a half months before the initial enrollment period ends, only 21.6 percent of Kentuckians who have signed up for a health plan are aged 18 to 34. The new health-insurance system depends on young people's signing up at higher levels to prevent premiums from skyrocketing, but just how high is open to question.

Kynect Director Carrie Banahan talked about healthinsurance with a man in Pikeville last summer.

However, leaders of the Kentucky Health Benefits Exchange say they are not worried — for a variety of reasons. "It's early," Carrie Banahan, executive director of the exchange, branded as Kynect. "That's just coverage for the month of January, so we're not concerned."

Nationally, 24 percent of those who have bought insurance plans through government exchanges have been 18 to 34. Some insurance experts have estimated that the young need to account for 38 percent of total enrollment in order for insurance companies to keep premiums at approximately the same levels they had to guess at for the first year of the new system.

But those estimates were made without much knowledge of how much under-35 enrollment insurance companies were expecting in the first year and how that influenced their premium prices. "Health plans expected that the first year would be rough, so they preemptively limited their exposure," Sarah Kliff reports for The Washington Post.

"They don't really care what goal the White House set for young adults," Kliff writes. "What matters to them — and what will determine if rates need to increase
next year — is who they expected to sign up." She quotes Aetna Inc. CEO Mark Bertolini as saying the national under-35 share was better than he expected, and this from Wayne DeVeydt, chief financial officer of Wellpoint, the largest company in the Blue Cross Blue Shield Association: “Things aren’t necessarily way out of whack with our expectations. It’s not about whether or not you're getting a sicker book [of business]. It’s whether you priced for it.”

When the companies set rates for this year, they were working with estimates of the age mixes in their risk pools would be, said Bill Nold, deputy executive director of Kynect. Final enrollment numbers won't be known until after March 31, the end of the regular enrollment period for the first year of coverage.

When Massachusetts implemented a similar plan several years ago, young people were slow to sign up, 22.6 percent of those who signed up in the first three months were aged 18 to 34. When enrollment ended, they made up 31.7 percent of the total.

One reason for the relatively small enrollment by 18-to-34-year-olds in private insurance plans is that 75 percent of those who have obtained coverage on the exchange have enrolled in Medicaid, the federal-state program for the poor and disabled. Almost 36 percent of the new Medicaid enrollees are under 35. They make up 32 percent of the combined enrollment of Medicaid and private plans.

Why is that" Perhaps because Kentucky is a low-wage state, and young people tend to have lower wages. The reform law, and Gov. Steve Beshear, made people earning up to 138 percent of the federal poverty threshold eligible for Medicaid, at no cost to them.

Banahan noted other possible factors: People who have purchased plans outside the exchange weren't included in the statistics it released, and the health-reform law allows young adults to remain on their parents' plans until age 26. That strengthens the financial stability of insurance plans, because young people have fewer claims.

Kynect required insurers to offer people under 30 a lower-cost plan that covers only catastrophic health events and does not offer the subsidies that apply to other private plans in the exchange. So far the plan has only 523 enrollees, 1.5 percent of the total, Banahan said.

Asked if the number was smaller than she expected, Banahan said, "I don’t know if we even made a prediction." She said one reason for the few enrollments might be the lack of subsidies, but illustrated how cheap such plans are, saying that in Lexington, a 20 year-old can get the highest level of plan for $130 a month.

There has been at least one surprise for those running the new system in Kentucky: 12,717 people bought a health plan without a subsidy. Banahan said that surprised her, and she attributed it to the convenience of signing up online.

Around the time the system began on Oct. 1, there were anecdotal reports that some people who qualified for subsidies said they didn't want them because they didn't want to accept government assistance. Asked about that, Banahan said, "The only thing we're really hearing is that people don't want to take the Medicaid . . . Some say please dis-enroll me from Medicaid" and agree to pay "the sticker price," the premium without any subsidy, Banahan said.

Nold said that while people may have a negative reaction to the word "assistance," but should remember that the subsidy is actually a tax credit, which will be refigured when they file their tax returns. He said the subsidy is "a reduction in an individual's taxes. . . . It is assistance, but it's assistance through the tax system."

On the 2014 tax returns, the amount of "advanced premium tax credit," or subsidy, "will be recalculated based on income and the plan they chose; some may have to pay more because they got too much tax credit, and some people might not have taken enough APTC and will have more tax credits," Nold said.

UPDATE, Jan. 17: Kynect reported Friday that it had enrolled 162,099 people, 122,328 of them in Medicaid. The Medicaid share was 74.46%, down from 82 percent two weeks earlier. Private plans enrolled 39,771, and 27,054 of those received a subsidy to reduce their premium.

Kentucky Health News is an independent news service of the Institute for Rural Journalism and Community Issues, based in the School of Journalism and Telecommunications at the University of Kentucky, with support from the Foundation for a Healthy Kentucky.

The Kentucky Health Benefits Exchange contact center has been in unusually high demand this week because of the Wednesday, Jan. 15 deadline to sign up for a health care plan. Some insurance agents have voiced concerns about long waits, unreturned phone calls and slow issuance of insurance cards.

"People had to select a plan by January 15 to have a 1/1 effective date," said Carrie Banahan, executive director of the exchange, branded as Kynect. "We allowed an extension, and people are calling at the last minute."

It's a complicated process. Transactions must take place, the information has to reach the insurance companies, and the companies must send out invoices and cards, said Bill Nold, Kynect's deputy executive director. Banahan said it could take seven to 10 days after a premium is paid for policyholders to receive cards certifying they are insured.

"All of this has kind of come to a head just in the last week or so," said Nold, "but probably not as quickly as people had hoped, and there's some frustration."

To help resolve the problem, a special phone number will be available for agents and the exchange's paid "kynectors" to call, Banahan said. More than 30 people will be staffing the phones and will become familiar with the unique issues that agents and kynectors are experiencing, Banahan said.

Tuesday, January 14, 2014

The MTV show "16 and Pregnant" has been highly criticized, not
only for featuring pregnant teens, but because some of the cast members
have since been arrested, gotten into trouble with drugs and alcohol,
and one was featured in a sex tape. But, a study by researchers at the University of Maryland and Wellesley College for the National Bureau of Economic Research
found that the show has actually helped lower the national rate of teen
pregnancies, which are significantly higher in rural areas than urban
ones. (MTV photo)

The rate of teen births dropped an average of 2.5 percent per year from
1991 to 2008, but from 2009, when the show premiered, to 2012, teen
pregnancy has dropped 7.5 percent per year, according to the study. But
it remains high. In 2012, more than 29 out of every 1,000 girls in the
U.S. between the ages of 15 to 19 got pregnant, a rate higher than in
any other developed country. In 2010, the rate was 33 per 1,000 girls,
and in rural areas, 43 per 1,000, according to the National Campaign to Prevent Teen and Unwanted Pregnancy.

While national numbers have decreased, Kentucky has not fared as well. In 2008, Kentucky was ranked 19th in the U.S. in pregnancies among girls and women 15-19, but in 2011, it ranked seventh, according to the U.S. Department of Health and Human Services. In 2011, the state had 6,111 known pregnancies among older teens and 6,127 among girls under 20. The rate of teen pregnancy dropped 37 percent from 1991, when there was an all-time high of 61.8 births per every 1,000 girls, to 2011, but dropped only 6 percent from 2010 to 2011. In 2011, the national average was 31.3 births per 1,000 girls and women aged 15-19, but in Kentucky the number was 43.5. (Read more)

For county-by-county data on teen births, from KentuckyHealthFacts.org, click here.

Part of the study focused on social-media trends "to see whether locations with higher search activity and tweets about '16
and Pregnant' showed higher levels of searches and tweets about birth
control and abortion," Jacque Wilson reports for CNN.
"They did. The researchers also looked to see whether high viewership
in certain areas corresponded with a bigger drop in teen births. It
did."

Melissa Kearney, one of the study authors, told Wilson, "Shows that make
it clear how hard it can be . . . affect girls who might
not care otherwise. You see she's fighting with her
boyfriend on a daily basis. She's gaining weight. Her friends are
partying without her." That's why the researchers credit the show for
helping lower the teen pregnancy rate, because it highlights "the
difficulties of raising a child at such a
young age and have concluded from this coincident timing that the show
is at least partially
responsible for the recent decrease in teen childbearing rates,"
according to the study.

"Our estimates imply that these shows led to a 5.7 percent reduction in
teen births that
would have been conceived between June 2009, when the show began, and
the end of 2010. This
can explain around one-third of the total decline in teen births over
that period," the researchers write. "Data limitations
preclude us from conducting separate analyses of pregnancies and
abortions, but we note that
teen abortion rates also fell over this period. This suggests that the
show's impact is attributable to a reduction in pregnancy rather than
greater use of abortion." To read the study click here.

The toughest challenge in passing a local smoking ban is ensuring that some in the community don't see it as a personal attack on their livelihood, character or heritage, say two public-health directors who succeeded in the effort.

Jim Rousey, retired director of the Madison County Health Department, and Clark County Director Scott Locakard spoke in the latest installment of a series of recollections presented by smoke-free advocates on WUKY-FM, the radio station of the University of Kentucky.

Noting the rich heritage Madison County had in tobacco, which generated much of the county's wealth and tax base, Rousey said it was important for him and his board to respect this history as they worked toward passing a smoking regulation in 2007.

"In every opportunity we wanted to acknowledge that rich heritage, which of course was [developed] way before we had the science connecting the hazards of tobacco and tobacco smoke to public health," he said. "So that was probably one of the biggest challenges that we had was in honoring that rich tobacco history we had."

Lockard, who works in an adjoining county, agreed that it was important to acknowledge the importance that tobacco played in the community as he and his board pushed toward the smoking regulation the Clark County Board of Health enacted in 2009.

"People felt like you were attacking their heritage, their history and you were saying that they were bad people for being associated with tobacco growing," Lockard said. "That was the farthest thing we were trying to communicate, and I always tried to make it as clear as possible that we acknowledged the importance that tobacco has played in our community."

In Madison County, some suggested applying the smoke-free regulation in restaurants only. One told a story that strongly influenced Rousey to push to include all public places. The man told him about how difficult it was to be an older employee with asthma in a workplace that allowed smoking. He said he felt that he was unable to find another job that had the same benefits or pay.

Lockard said many business owners in his community urged the health board to make the smoke-free regulation include all businesses because they wanted to go smoke-free but did not want to risk alienating some customers.

Five local health boards in Kentucky have passed smoking regulations. The Bullitt County Board of Health passed one in 2011 but the regulation is being challenged in court by the Bullitt County Fiscal Court. The case is before the state Supreme Court, but the fiscal court is planning to pass an ordinance that would invalidate it while banning smoking in the county's public buildings.

The outcome of the controversy could influence whether counties with health-board smoking rules, like Clark and Madison, get to keep them or whether other counties will follow their examples.

Rousey's and Lockard's stories are part of StoryCorps, an independent non-profit whose mission is to provide people of all backgrounds and beliefs with the opportunity to record, share and preserve the stories of their lives. To listen, click here.

Monday, January 13, 2014

A simple blood test can tell whether a woman has cervical cancer and, if she does, "how far it's spread," writes Laura Ungar of The Courier-Journal, reporting on research findings from the University of Louisville.

The test "a heat profile from a patient’s blood called a plasma thermogram," Ungar reports. "Researchers
hope it can be used along with Pap smears to detect cervical
abnormalities, monitor disease progression and help doctors develop more
personalized treatment plans by tracking how patients respond to
specific medicines."

Researcher Nicholas Garbett "expects the test will be widely used eventually, but she
doubts that it will ever replace the Pap smear, in which cells are
scraped from the cervix and examined under a microscope," Ungar writes. “You could test more frequently,” Garbett said.

Her business associate, Dr. A. Bennett Jenson, "said the new test could be
more accurate, since Pap tests have a 37 percent rate of false negatives
or false positives," Ungar reports. "Jenson said the experimental plasma test now costs around $250, but if the
volume is increased so many blood samples are handled at the same time,
the price could drop to $15 or less. Pap smears cost $20 to $30."

Kentucky ranks eighth in cervical cancer, which is especially prevalent in the state's Appalachian region. There, the rate in 2010 was 9.7 per 100,000 women. The state's rate was 8.6 and the national rate was 7.4, Ungar notes.

More Kentuckians had health insurance through their employer last year than the year before, and fewer were on public insurance, according to a statewide poll taken last fall.

Both results reversed trends the poll had found in the previous four years, away from employer-provided insurance and toward public insurance such as Medicare and Medicaid.

The share of Kentuckians who said they had employer coverage rose to 44 percent in 2013 from 37 percent in 2012. The share who said they were on on public insurance dropped to 20 percent in 2013 from 27 percent in 2012.

The margin of error in the Kentucky Health Issues Poll was plus or minus 2.49 percentage points, applied to each number in the results, so the differences in the 2012 and 2013 numbers were beyond the error margin. The poll surveyed 1,551 Kentucky adults aged 18 through 64 by telephone, with 951 land-line interviews and 600 cell-phone interviews Oct. 26 through Nov. 25. Seniors were not surveyed because 99 percent of them have some form of health coverage, the Foundation for a Healthy Kentuckysaid in releasing the poll results.

"Further research will be required to determine whether this is a temporary upswing or signals a shift in the source of health insurance for Kentucky adults," said the foundation, which funds Kentucky Health News and sponsors the poll with Interact for Health, formerly the Health Foundation of Greater Cincinnati. The polling is done by the Institute for Policy Research at the University of Cincinnati.

Janie Miller, CEO of the new Kentucky Health Cooperative, a not-for-profit insurer, said through spokeswoman Susan Dunlap that employer coverage could have increased through "early adopters" in the business community who saw Obamacare as a chance to cover their employees for the first time, and people between 21 and 26 who were added to their parents' policies under a part of the law that took effect in 2012.

Could an improving economy also have contributed? Ron Crouch, director of research and statistics for the state Workforce Development Cabinet, was skeptical. He said the number of Kentuckians on food stamps went up from 2012 to 2013, and many people who went back to work did so at part-time jobs with lower pay and little or no benefits.

"I would not have expected that trend in that one year," Crouch said of the shifts. "It sort of seems like an outlier result." In statistical sampling, an outlier is a rare case that is not covered by a standard margin of error. The poll's error margin was calculated to provide accurate results in 95 out of 100 cases, the most commonly used standard. The pollster, Eric Rademacher, did not respond to a request for comment.

Through Nov. 10, the midpoint of the poll, more than 40,000 Kentuckians had signed up for coverage on the state health-insurance exchange -- about 7,000 for private insurance and the rest for Medicaid. That could skew the numbers toward public insurance, but Crouch and foundation CEO Susan Zepeda noted that those plans didn't take effect until Jan. 1. Thus, there would have been no impact if people who got coverage from the exchange answered precisely the question "Which type of health insurance do you now have?"

Twenty-five percent said they were uninsured, down from 28 percent a year earlier. Another 8 percent said they lacked coverage at some time in the previous 12 months. The total of 33 percent was a clear decline from 40 percent in the fall 2011 poll. (The 2012 figure was 37 percent, not enough year-to-year difference to exceed the error margins.)

Among people earning up to 138 percent of the federal poverty threshold, who are now eligible for Medicaid under health reform, just over a third (34 percent) said they were without insurance in the previous 12 months. The percentage was the same for people earning up to 200 percent of the poverty line. People earning up to 400 percent of the poverty line are eligible for subsidies for private insurance through the exchange.

Kentucky Health News is an independent news service of the Institute for Rural Journalism and Community Issues, based in the School of Journalism and Telecommunications at the University of Kentucky, with support from the Foundation for a Healthy Kentucky.

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Kentucky Health News is an independent news service of the Institute for Rural Journalism and Community Issues, based in the School of Journalism and Media at the University of Kentucky, with support from the Foundation for a Healthy Kentucky.Republication of any KHN material with proper credit is hereby authorized, but if the republication is longer than a news brief we ask that it contain the first sentence of this paragraph. Thanks!